When any answer is a good answer: A Mandated-choice model for advance directives

The goal of a mandated choice is not to coerce people into making decisions that contravene their consciences but rather to help them to maximize their own autonomy. As such, any workable statute would permit an opt-out provision for conscientious objectors who hold philosophical or religious views incompatible with making any choice at all. (However, the bureaucratic obstacles to opting out should be relatively high?possibly requiring a personal appearance and the execution of an affidavit?to prevent conscience from becoming a refuge for the lazy.) At the same time, the vast majority of Americans should be expected to meet their civic responsibility and either (1) executive a living will or (2) appoint a proxy to make decisions for them in cases of incapacity. Those unsure of their wishes and without someone they trust to make decisions for them could designate the physicians at the hospital where they eventually receive care as their proxies, enabling their providers to exercise substituted judgment on their behalf. The ultimate hope would be for teenagers to sit down with their families and to discuss their perspectives on end-of-life care in a reciprocal conversation that might also educate them as to their parents? and siblings? wishes. Mandated choice, nurtured in this familiar setting, could foster the discourse on death and dying that our society sorely lacks. The time for such a compulsory program has arrived. Maybe it is long overdue. Yet the best prospect for such a policy requires a concomitant cultural shift on public attitudes toward advance directives and end-of-life care more generally, which in turn should result from carefully crafted mandated-choice legislation.